Medical Claims Specialist

Modern OB/BYN is committed to delivering compassionate and personalized obstetric and gynecologic care to every patient. Our dedicated team upholds high standards of excellence, ensuring that each patient feels valued, listened to, and cared for during every visit.

We are seeking a detail-oriented and motivated Medical Claims Specialist to join our healthcare team. In this role, you will be responsible for managing medical claims processing, ensuring accurate coding, and facilitating smooth reimbursement procedures. The ideal candidate will possess strong knowledge of medical billing, coding systems, and contribute to efficient revenue cycle operations.

Responsibilities include:

• Review and process medical claims using appropriate coding systems such as DRG (Diagnosis-Related Group), CPT (Current Procedural Terminology), ICD-9, and ICD-10.
• Ensure accuracy in medical coding by applying ICD coding standards and medical terminology correctly.
• Analyze medical records and documentation to verify claim details and support billing accuracy.
• Collaborate with healthcare providers to clarify or obtain additional information needed for claim submission.
• Maintain compliance with healthcare regulations and insurance requirements related to medical billing and collections.
• Utilize EMR (Electronic Medical Records) system efficiently to manage patient data and claims information.

Qualifications:

• Proven experience in medical billing, medical coding, or claims processing within a healthcare setting is preferred.
• Strong knowledge of DRG, CPT coding, ICD-9, ICD-10, and related coding standards.
• Familiarity with medical terminology, medical records management, and healthcare documentation practices.
• Experience working with EMR systems and EHR platforms for data entry and claims management.
• Excellent attention to detail with the ability to identify discrepancies or errors in medical records or billing information.
• Effective communication skills for collaborating with providers, insurance companies, and patients.